Handout Internal Family Systems Model

9/15/23
IFS: COMPASSION FOR

ADDICTIVE PROCESSES
Cece Sykes LCSW ACSW
ifs-institute.com
cecesykeslcsw.com
Overview
TALKING POINTS
What is the Internal System?

Defining Parts
Moving from Old Definitions to New
Defusing Polarities
Cultivating Compassion
Treatment Considerations
References
cece sykes lcsw • 2023 3
Internal Family System (IFS)

Psychotherapy Model
◦ Evidence-based model of psychotherapy

◦ Developed 1980’s; Richard Schwartz, Ph.D
in Chicago; research with eating disorders
◦ Internal Family Systems Therapy ; 1995;
◦ 2nd Ed. 2020; 40+IFS books
1
9/15/23
IFS BASIC
S e lf - inte rn a lize d , e m b o d ie d
state o f ca lm , w itn e ssin g ASSUMPTIONS
M u ltip licity - m a d e u p o f
su b p e rso n a litie s ca lle d Pa rts
Eve r y th in g is a Pa rt! T h o u ghts,

Fe e lin gs, S e n satio n s
Psych e is a syste m : " A ny e ntity

w h o se p a rts re late to o n e
a n o th e r in a p atte rn ."
4 cece sykes lcsw • 2023
Self…..
◦ Our essence, soul, inner voice, inner knowing;
buddha nature; embodied; spiritual
◦ IFS: clients felt ‘more like themselves’
◦ Inborn and released, not acquired
◦ Self and addictive process; desire to be whole;
feel better; inner voice (even when ‘high’);
◦ Pause; Available in moments
“Self is Not Being Happy;

Self is Being Aware” cecesykes
Self….Revealed
2
9/15/23
Eight C’s of Self Energy

Calm
Creative
Connected
Compassionate
Confident
Clarity
Courageous
Curiosity
+ Choice (9th C)
©cecesykeslcsw
Multiplicity is normal, but not easy!

….feels chaotic
What are Parts?

Thoughts, feelings, sensations, memories,
temperment
Role: Impacted by environment
Adaptive: Have a positive intention
Become extreme in burdened system
Develop relationships
polarities and alliances
3
9/15/23
Treating a System, Not a Symptom

Managers FF/Distracters
• Escape/Soothe
• Stabilize/Improve
• Present-oriented
• Future-oriented
• Proactive SELF •
•
Reactive
Reject/Concealed
• Over-identified
• Absorb Energy
• Past-oriented
Exiles • Overwhelming
• Repress/Ignore
© cece sykes lcsw
10
Managers: Never Again!

“If I do it right, I’m not a bad person”
Positive Intentions: Functioning + Stability

responsible, rational; thoughtful,
planner, analyzer, caretaker, achiever,
helper, cautious, approval-seeking
Extreme/Add Process:
Contempt + Control -over-responsible,
unemotional; cold, contemptuous, hostile,
blamer/shamer, perfectionist, chronic self-
sacrifice, chronic rescuer and “fixer”
© cecesykeslcsw
11
Managers:
Functional, Stressed, Striving
12
4
9/15/23
Managers: To the Rescue
13
Firefighters/Distractors/Soothers
Often dismissed, reviled; don’t care; heroic, defiant,

‘take bullet’ for system; adolescent energy
Higher risk – heavy alcohol/drug use;
compulsive gaming, sexual preoccupation,
dissociation; gambling/debt; disordered eating, self-
harming; rage, suicide, violence
Lower risk-a few drinks, occasional drugs; social
media, TV, shop/spend, sports/exercise; video games,
sleeping; flirting; irritation; spacing out, mild food
preoccupation
14
Firefighters/Distractors
…whatever it takes
Often dismissed, reviled; don’t care; heroic, defiant, ‘take bullet’ for
system; adolescent energy
Positive Intentions: medicate and balance
Protecting the system: Put out exile’s emotional fires
Balancing the system: shifts gears to balance
manager/exiles energy ; promote rest, relaxation,
pleasure, fun, lightness, play, sweetness; adventure
avoid, distract, medicate painful emotions; heroic-doesn’t care

about consequences; doesn’t accept feedback;
defends against judgmental parts; won’t step back till exiles are better
15
5
9/15/23
Pain Medication
16
17
Exiles: Our Vulnerability

◦ Originally can be innocent, trusting, carefree, playful, sensitive,
open-hearted; not all are burdened; our shared humanity
◦ Absorb energies in the field + or –
◦ Feel young, small, alone; “Pain in Isolation”
◦ Hold memories: “implicit memory;” on back burner of everyday
consciousness
◦ Show ‘randomly” up as story/memory
◦ Burdened with false beliefs; feel
unchangeable and “true”
◦ Have self energy-know their needs
18
6
9/15/23
“ Pain in Isolation”
19
ADVERSE CHILDHOOD EVENTS STUDY (ACE)
Kaiser-Permamente 1995-1997 inter viewed `17,000 people to

measure total amount of stress in childhood
Defines "Adverse Childhood Experiences" as exposure to:
• physical, emotional, sexual child abuse

• neglect
• housing /food insecurity
• domestic violence
• household members abusing alcohol or drugs
• loss of parent/divorce
14
cece sykes lcsw • 2023
20
ACE: Trauma, Health, Addictive Process
◦ High ACE score = increased substance use x 7

◦ Attempted suicide x 12
◦ ACE five+ 7-10 x higher risk ‘street’ drugs;
3x misuse prescription drugs due to chronic pain
◦ 2020: deaths: 440,000 nicotine; 88,000 alcohol;
◦ 110,000 drugs (1/3 opiates)
◦ 300,000 deaths/obesity
◦ ANAD-30 million: more risk than bipolar/depression;
◦ Gaming industry -150 billion/year
◦ Porn-hub - 28 billion visits/year; 81m. per day
21
7
9/15/23
PA RTS IN D E V E LO PM E N T

S u b -p e rs o n a litie s : M a ny p re s e nt at b irth
N ew p a rts e m e rge a n d d eve lo p ove r tim e
Pa rts h ave a S e lf a n d a p refe rre d ro le
M a n a ge rs a n d firefig hte rs o rga n ize to p ro te c t th e syste m
E x ile s d eve lo p b u rd e n s ove r tim e
Managers and firefighters become extreme and

polarized when they disagree about how to provide
safety
22
TRADITIONAL DEFINITIONS
"Addiction is a complex condition, a brain disease that is

manifested by compulsive substance use despite harmful

consequence...changes in the brain are what cause people
to have intense cravings for the drug and make it hard to
stop using the drug."
American Psychiatric Association
"Addiction is a treatable, chronic medical disease involving

complex interactions among brain circuits, genetics, the
environment, and an individual's life experiences. People with
addiction use substances or engage in behaviors that become
compulsive and often continue despite harmful consequences.
Prevention efforts and treatment approaches for addiction are
generally as successful as those for other chronic diseases."
American Society of Addiction Medicine 2019 13
23
Psychological Definitions: A Process

A chronic polarity between two sets of
extreme parts: critical, controlling (M) and
avoidant, soothing (FF/D); both try to protect
exposure of buried (E) emotional pain.
IFS/Sykes
Pain medication- coping with complex trauma
Gabor Mate’
Addiction shouldn’t be called 'addiction.’ It should
be called “ritualized compulsive comfort-seeking.”
Sumrok MD; Addiction Sciences, U Tenn
Dependence on or commitment to a practice,

habit or substance to the extent that cessation
causes trauma. Kemerman Webster’s
Anything we lie about. Anne Wilson Schaef
24
8
9/15/23
WHAT CAN TREATMENT LOOK LIKE?
• Treat people with respect instead of blaming or

shaming them.
• Listen intently to what they have to say.
• Integrate healing traditions of the culture in
which they live.
• Use prescription drugs, if necessary.
• Integrate Adverse Childhood Experiences
science (ACEs)
17
25
IFS for Addictive Process
◦ Therapist Self views client as system

◦ ‘Using FF’ protective, positive intention
◦ Manager/FF are hinged, treat polarity
◦ Reinforce functioning: Self Detector
◦ Creating inner connection = new
neuropathways
◦ Connect to exiles –trauma , alienation and
wounds
◦ Integrate w/ professionals and groups
26
Core Indicators
Impulsive
Done without thinking: “ It just happened…”
Compulsive
No choice anymore: “I had to…”
Ignore Consequences
Disdain or Denial of Risk and Costs
“Nothing else matters…”
27
9
9/15/23
Firefighter/SootherQualities
◦ Appear chaotic, invite management

◦ Narcissistic, self-absorbed
◦ Resist feedback (pressure to change)
◦ Protect role at all costs
◦ Intentions: escape, distract, medicate, avoid painful emotions
◦ Fears: Managers won’t rest; Exiles flood system
Heroic; Won’t leave their post if exiles not safe cecesykeslcsw
28
P O L A R IZAT IO N : T H E BAT T L E F IE L D
BLAME FLAME
E X IL E
29
SYSTEMIC ADDICTIVE PROCESS

EXTREME MANAGER = EXTREME FIREFIGHTER
30
10
9/15/23
Paradigm Shift :
Judgment or Compassion?
◦ Not - why the addiction…..Why the Pain? (Mate’)

◦ Not - Why are you doing that to yourself? ……How is that part trying
to help you? (IFS)
◦ Not - Why do you have to be so checked out?…..What are you
afraid would happen if you were here, more aware? (IFS)
Never an Excuse……
Always a Reason
31
Key Managers
◦ Caretaker-self-sacrifice own needs; focus on
fixing other’s inner world
◦ Controller-one right way (mine!)
◦ Perfectionist- cannot make a mistake
◦ Critic- only see what’s wrong
◦ Judge: shames and evaluates everything:
Nover good enoughcan’t win!
“If you ask a question and the answer cannot

be No,
it is not a question, it is a command.”
32
IFS – Paradigm Shift

GET IN RELATIONSHIP VS GET IN CONTROL
•Treating a system, not a symptom
•Positive intentions of negative behaviors
•Firefighters do all the wrong things for all
the right reasons
19
33
11
9/15/23
Community
34
Collaboration: We are in this Together

“I am not here to take this away from you.”
◦ Creating a vision : what do you want from therapy?

◦ Start in here and now - creates safety
◦ Ask about parts not ready, nervous, or hopeless
◦ “…Not in charge of your sobriety plan…”
◦ Assume relapse or recurrence
◦ How have you worked on this ? Previous therapy?
◦ Ask abt less risky FF/D; ie screen time, work, music,
exercise, food; sports
◦ Never an excuse, Always a reason
◦ Choice: “The Ninth C”
35
IFS Advantage
After extended using of substances and practices brain is altered
Initiative and attachment are impaired
Pre-frontal cortex-judgment and decision-making
Choice : impaired
“Brain, impaired organ, needs to initiate its own healing process….”
IFS: Building self – to – part connections =
accessing mind to heal the brain
36
12
9/15/23
Polarizations
24
Two sets of parts protecting the system using

conflicting approaches
• System seeks homeostasis

attempting balance.
• Client blends with both

sides.
• Each side/team has positive

intentions.
37
Polarizations
The degree to which

Firefighters/Distractors engage in
destruction of Self and others
equals
the degree of inner emotional
abuse by Managers.
12
38
Common Polarities
◦ Never Use vs Must Use

◦ In Control vs Out of control
◦ Work hard vs Indulge
◦ Do for other other vs Do for me
◦ Approval Seeking vs Rebelling
◦ Tell the truth vs Hide the truth
◦ Compliance vs Autonomy
◦ Organize vs Chaos
39
13
9/15/23
Working with
polarizations
Boat at Sea: Delicate balance with Self at helm.
Any part moves or changes causes everyone to be unsteady.
Connect to Self to reassure and create smooth sailing.
Conference table: Client/Self seated at head, parts in battle across

the table. Managers at the right hand, exiles at foot of table.
Everyone gets only one chair.
Accept both sides as essential and needed.

Make connection. Protectors turn to Self. 28
40
Self Spectrum: Conscious Awareness
Transcendence
Dissociation
Flooded Blended Self-led Self
© cece sykes lcsw
41
U S IN G S P EC T U M : C H O IC E , R IS K , AWA R E N ES S
Dissociation Transcend
Loss of reality/no connection Enhanced reality/no separation
F LO O D E D BLENDED S E L F -L E D SELF
CHRONIC USE Frequent Heavy Use Regular Use Occasional Use Spiritual
LIT TLE/NO CHOICE high risk/less choice less risk/some choice full choice or ceremonial use
very high risk high consequences medium consequences few consequences
chronic direct access/insight insight/direct access insight
consequences
direct access
cece sykes lcsw & mary kruger lcsw
42
14
9/15/23
Get in Relationship, Not in

Control
◦ Traditional addiction therapy-fights or tries
to control FF/S/Using parts
◦ IFS goal is create self-to-part with Using
parts:
“I just want to get to know you.”
“I am not here to change you.”
“Other parts have tried to shame you,
but I am not those parts.”
“There is more to you than meets the
eye – you’re more complex than you seem.”
43
Compassion for “Using” Parts

◦ When did FF start: What was happening to exiles
when FF got started- family
◦ Client can visualize FF to detach
◦ Positive intention for negative behavior
◦ Acknowledge wisdom of ‘getting away’
◦ Normalize fears of exiles: 1-way street
◦ Tracking – day in the life, context
◦ Risks- Identify intended vs unintended
◦ Choice: “The Ninth C”- Freedom to choose
© cece sykes lcsw
44
What is tracking? ……
Identifying Inner Sequences, Finding Pattern
C. External Stressor: “...My partner yelled at me…”

T. How did that impact you?
C. “I felt Angry….”
T. What part did you show your partner?
C. “Shrugged, said okay…” Or, “I yelled at them…”
T. Then what happened?
C. Later that night I “… ate, got high, gambled/porn….”
T. How did that feel?
C. “Great! Then I did some more…. Then I passed out.”
T. Then what happened?
C. I woke up. I felt terrible….
T. Okay, can I reflect this back to you?
45
15
9/15/23
Transitions: Ask
◦ How do you wake up? Mood, parts, medications?

◦ What to do when you finish work ?
◦ How do you transition to sleep?
◦ How do you unwind and resource?
◦ Where, when do you eat, w/ whom?
◦ In family arguments-substances used?
◦ Anger, preoccupations; what happens after a ‘using’
time…..
◦ cecesykeslcsw
46
39
Compassion
for Difficult UNBLEND
Managers believe they are the Self
Managers BE CURIOUS
Can you feel it now? What qualities?
What are its thoughts? Any negative
attitudes?
REASSURE THE PART

"We are not here to get rid of you."
Respond to fear of overwhelm of FF/E
PROVIDE COMPASSION
""You are working so hard!"
47
Interview Manager: 3 Questions

Find, Focus, Flesh out/Find out….
Ask the part: When you try to get me to do this (activity/behavior )
what is your intention or mission? How are you trying to help? How long
have you had this role?
Ask the part: What are you afraid or concerned will happen if you stop
doing this behavior?” What are other fears or worries?
◦ Acknowledge their hard work; their fears are realistic, they have legitimate
concerns
Ask the part: If you saw there is another way to keep this EXILE safe,
would you consider not working so hard ?
48
16
9/15/23
Mini-Unblend
◦ Useful esp in beginning to offer new experience with less stress, slows
process down
◦ Helpful if client intellectualizes, fears inner world or body focus, can’t
’stay inside’ for long periods
◦ Offers template for appreciation and awareness
Pause
Let’s just pause, that was so important, helpful…
Breathe
Let’s take a breath together…
Notice
What is coming up as your talk about this, what are you noticing or
aware of right now??
Connect
Can you connect to that part, show it you notice it?
cecesykeslcsw
49
Exiles / Despair
50
33
INTRODUCE THE NINTH C

WHAT IF YOU HAD A CHOICE?
51
17
9/15/23
Hope: New way to help

Exiles??
Choice:
The Ninth C
If there was another way

to handle the pain,
would that give you a break??
52
WHAT EXILES WANT

22
A relationship
attachment, connection
they long for love and care
Be heard and accepted as they are

safety and stability
to know that you will come back to them
Unburdened from old, toxic beliefs

Hear their story (client may not have
been heard) - be their witness
Other parts fear there is no cure for Exiles
41
53
IFS Advantage
After extended using of substances and practices brain is altered
Initiative and attachment are impaired
Pre-frontal cortex-judgment and decision-making = Choice : impaired
“Brain, impaired organ, needs to initiate its own healing process….”
IFS: Building self – to – part connections = accessing mind to heal the
brain
54
18
9/15/23
21
" J u st l i ke w i t h ex te r n a l e co l o g i e s ,
c h a n ge s i n o n e a s p e c t ca n h ave
u n fo re s e e n co n s e q u e n c e s . T h i s i s Traumatized inner systems
fa r l e s s l i ke l y, h o w e ve r, i f yo u t h i n k are delicate ecologies.
i n te r m s o f syste m s - - t h e n t h e
co n s e q u e n c e s o f te n ca n b e
fo re s e e n a n d p re e m p te d o r d e a l t
w i t h f ro m S e l f "
"NO BAD PARTS" RICHARD SCHWARTZ
55
IFS Addictive Process Treatment

Therapist brings Self to client's whole system
Welcome 'Using Firefighters' as protectors with a positive
intention
Build inner relationships
Create new inner connections (neural pathways)
Integrate with professionals and groups
Treat trauma - heal early childhood experiences (Exiles)
56
Managing our Vulnerability
57
19
9/15/23
Overview of Model
◦ Create connection; external constraints
◦ Reflect client narrative as “parts”
◦ Vision for therapy
◦ Learn about protectors; track system
◦ Build inner connections

◦ Identify Exiles (vulnerable part)
◦ Witness exile story: compassion
◦ Unburden core beliefs
All Roads Lead to Rome (Exiles)
58
21
" J u st l i ke w i t h ex te r n a l e co l o g i e s ,
c h a n ge s i n o n e a s p e c t ca n h ave
u n fo re s e e n co n s e q u e n c e s . T h i s i s Traumatized inner systems
fa r l e s s l i ke l y, h o w e ve r, i f yo u t h i n k are delicate ecologies.
i n te r m s o f syste m s - - t h e n t h e
co n s e q u e n c e s o f te n ca n b e
fo re s e e n a n d p re e m p te d o r d e a l t
w i t h f ro m S e l f "
"NO BAD PARTS" RICHARD SCHWARTZ
59
Goals of IFS Therapy

Relationship Building
Ecology of inner world: every protective part has a positive intention;
even negative behavior has adaptive function;
Exiles can be recovered, integrated and unburdened.
Goal of therapy is releasing parts from burdened roles by creating
connections between “Self” and “Parts;” integrates system and
enhances self-awareness through curiosity and non-judgment
60
20
9/15/23
Flow of Therapy: Two-way Street

T-Self
Managers Firefighter
/Soother
SELF
One-way
Client identifies parts
Two-way
Client builds self to part
rel’ship
© cece sykes lcsw

Exiles
61
Unburdened parts
pick new roles, adopt new
qualities
Introduce new activities that go hand in hand

with letting go of addictive process.
Parts may feel need to 'catch up' on what was

missed in their lives...healthy ways to
experience adrenaline rush, be unique, be a
rebel
44
62
Role of Therapist in IFS
◦ Build trusting relationship; Same basic history as in any clinical

approach
◦ Listen to their story-what do they need?
◦ Parts Detector: Reflect their states of mind/emotions as parts of
who they are
◦ Pause… Breathe… Notice
◦ What are their intentions for treatment?
◦ Invite to focus internally
63
21
9/15/23
SELF TO PART
HEART TO HEART
64
Treatment Considerations
Recovery is a process, not an event.
Expect ups and downs, slow progress, slips, etc.
For clients mandated to therapy, they may have to develop own reason for
being there, might differ from other people's reason for them being there.
Clients with addictive parts often feel helpless, hopeless, despairing.

Therapists need to be aware of their own parts that may come up who
can't tolerate despair...who have caretaker part that activates.
When a client is compulsive and self-destructive, their lack of judgment

pulls for action by the competent, managerial parts of the people around
the client.
45
65
Six F’s of Inner Dialogue: Inquiry
◦ FIND a Part; What do you want to work on?

◦ FOCUS – Center your attention on it
◦ FEEL TOWARD: Curious? Beginners mind?
◦ FIND OUT: Where in body? Do you see it?
What is it showing you?
◦ BE-FRIEND: Dialogue: Intentions? Story?
◦ FEARS: What is Part afraid would happen if it
didn’t perform this role ?
66
22
9/15/23
Common Fears / Reassuring Fears

1. Fear of exile flooding and 1. What if we help exiles not
overwhelming client flood; we can negotiate…
2. No benefit to “looking 2. What if looking back
means relief of pain?
backwards”
3. What if we work so FF is less
3. Might trigger the FF to take risk-taking or chaotic?
over again
4. Reassure, won’t judge;do
4. Therapist will react or reject they have judge part?
them 5. Never getting rid of a part,
5. Managers will lose their giving it options
position 6. Information stays ‘in the
6. Secrets will be exposed to room’
others 7. Decisions by self in
7. External world can’t handle connection, not one part
change
67
Five P’s of Self Energy

Perspective-how far you have
come….
Presence-available, accepting…
Persistence-trust the process….
Patience-solid connections pay
off….
Playfulness…..
68
Bibliography
◦ Sykes, C.C., Sweezy, M., Schwartz, R.C., (2023) Internal Family
Systems Treatment for Addictions; Trauma-Informed Compassion-
Based Interventions for Substances, Eating, Gambling and More.
PESI Publications.
◦ Schwartz, R.C., Sweezy, M. (2020). Internal Family Systems Therapy,
2nd Edition; New York. NY; Guilford Press
◦ Anderson, F., Sweezy, M., Schwartz, R.C. (2018) Internal Family
Systems, Skills Training Manual. PESI Publications
◦ Sykes, C.C. (2016) “An IFS Lens on Addiction: Compassion for
Extreme Parts,” in Sweezy, M. & Ziskind, E.L. (Eds), IFS Innovations
and Elaborations; New York, NY; Routledge
◦ Sykes, C.C. (2001) “Why I Love My Firefighters,” Self to Self IFSA
Journal, Vol.5 No. 6.
69
23

Handout Internal Family Systems Model

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Handout Internal Family Systems Model

Uploaded by

Copyright:

Available Formats

9/15/23

IFS: COMPASSION FOR

What is the Internal System?

cece sykes lcsw • 2023 3

Internal Family System (IFS)

◦ Evidence-based model of psychotherapy

Eve r y th in g is a Pa rt! T h o u ghts,

Psych e is a syste m : " A ny e ntity

4 cece sykes lcsw • 2023

“Self is Not Being Happy;

Eight C’s of Self Energy

Multiplicity is normal, but not easy!

What are Parts?

Treating a System, Not a Symptom

Managers: Never Again!

Positive Intentions: Functioning + Stability

Managers: To the Rescue

Often dismissed, reviled; don’t care; heroic, defiant,

avoid, distract, medicate painful emotions; heroic-doesn’t care

Exiles: Our Vulnerability

ADVERSE CHILDHOOD EVENTS STUDY (ACE)

Kaiser-Permamente 1995-1997 inter viewed `17,000 people to

Defines "Adverse Childhood Experiences" as exposure to:

• physical, emotional, sexual child abuse

cece sykes lcsw • 2023

ACE: Trauma, Health, Addictive Process

◦ High ACE score = increased substance use x 7

cece sykes lcsw • 2023

N ew p a rts e m e rge a n d d eve lo p ove r tim e

Pa rts h ave a S e lf a n d a p refe rre d ro le

M a n a ge rs a n d firefig hte rs o rga n ize to p ro te c t th e syste m

E x ile s d eve lo p b u rd e n s ove r tim e

Managers and firefighters become extreme and

"Addiction is a complex condition, a brain disease that is

manifested by compulsive substance use despite harmful

"Addiction is a treatable, chronic medical disease involving

Psychological Definitions: A Process

Dependence on or commitment to a practice,

Anything we lie about. Anne Wilson Schaef

WHAT CAN TREATMENT LOOK LIKE?

• Treat people with respect instead of blaming or

cece sykes lcsw • 2023

IFS for Addictive Process

◦ Therapist Self views client as system

◦ Appear chaotic, invite management

Heroic; Won’t leave their post if exiles not safe cecesykeslcsw

cece sykes lcsw • 2023

SYSTEMIC ADDICTIVE PROCESS

◦ Not - why the addiction…..Why the Pain? (Mate’)

“If you ask a question and the answer cannot

IFS – Paradigm Shift

cece sykes lcsw • 2023

Collaboration: We are in this Together

◦ Creating a vision : what do you want from therapy?

Two sets of parts protecting the system using

• System seeks homeostasis

• Client blends with both

• Each side/team has positive

cece sykes lcsw • 2023

The degree to which

cece sykes lcsw • 2023

◦ Never Use vs Must Use